What is the role of providers when it comes to patient engagement?

Patients often don’t get the respect they deserve. Take the subject of patient engagement. Just about everywhere you turn in the health care literature these days we are told how physicians and other providers need to do a better job getting patients involved in their own health.

But is that really their role?

Patient engagement is not the job of health care providers

Why? Because by the time a person (aka patient) presents for care in the primary care physician’s office, they are already engaged in their own care to some degree (albeit now necessarily in the way providers expect). Here’s what I mean.

People consult with their doctor when they have a need or concern which they believe needs to be addressed. Often times before they make an appointment to see the doctor, people will do their own home work to see if a doctor’s appoint is really necessary. Many of us for example will talk with a friend or family member or consult our favorite health website before deciding to see a doctor. A recent Wolters Kluwer poll on health found that of all people who go online for health information, 50% do so before seeing their doctor.

Next we must pick up the phone and make the appointment which itself requires time and dedication given office hold times. Then we must actually keep the appointment — telling ourselves that we are seeing the doctor for a good reason.

By the time we walk through the front door of the doctor’s office we are already engaged in our health as manifest by the cognitive involvement and expenditure of time involved with:

Deciding that we need to see a physician

Making and keeping their doctor’s appointment despite the self-talk that we will get better on our own

Preparing a mental list of issues/question that we want to discuss with the doctor

Given that people 50 years and older see their physician and average of 3-4 visits a year, they are already engaged in their own health — at least up until the time they walk into the physician’s office.

What happens in the doctor’s office plays a big role in determining whether the patient’s level of engagement grows, or is diminished if not extinguished. Physicians that are prepared for the visit, ask patients for their input, solicit patient expectations, beliefs and previous experiences, and where possible honors them, are demonstrating traits that patients find engaging, e.g. traits which encourage patients to persevere in their get involved in their health. Physicians who appear rushed, “not present,” not prepared, or who fail to solicit the patient’s input often have the opposite effect.

What is the role of providers when it comes to patient engagement?

Given that patients is the office are already engaged, albeit perhaps not is ways providers think of as engagement, the role of the provider is to create an atmosphere which facilitates, cultivates, and builds upon the level of engagement which patients bring to the office. This is accomplished when the physicians and provider staff consistent employ patient-centered communications with all their patients.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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What is the role of providers when it comes to patient engagement? 5 comments

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http://twitter.com/docpreneur Gretchen Campbell MD

in the context of a patient visit, I do believe it is the responsibility of the doctor to engage the patient. I often tell my patients and others that as a neurologist I can often diagnose a condition immediately after simply looking at the patient from my chair. The majority of the rest I can make a diagnosis (or narrow it down to 2-3) within the first 5 minutes of listening to the patient. The exam provides further confirmation a do most tests that we order. The remaining 15-20 minutes spent with the patient is to make the patient understand the diagnosis and the rational for further testing/medications if needed. I agree, patients come to us after plugging their symptoms into a search engine; but they come to us to make sense of it. As the expert in the room, it is our responsibility to make sure the patient is fully engaged in the discussion and understands the diagnosis and plan before they leave the room. we need 5 minutes, they need the extra 20-30 minutes. A parallel would be situations involving the many consultants that doctors require (CPAs, financial advisors, attorneys, etc). They may be able to look at a few documents provided by us and tell us what to do. The advisors I have kept make it their business to make sure I understand their recommendations. Their expertise is completely outside my purview and my “due diligence” reading only gets me so far, so there will always be questions that I won’t even know to ask. The same is true for our patients. we are the paid experts and should make sure (to the extent that we can) that patients are engaged and understand the diagnoses and recommendations that we make.

Steve Wilkins

As the risk of splitting hairs…what you describe are provider traits which patients find “engaging”..e.g., traits which tell them that you are interested and willing to listen to what they want to tell the physician but often don’t due to lake of time, apparent provider disinterest, fear and so on. If they weren’t already engaged to some extent they would not be in your office.

All to often lack of time and provider-directed communication styles tend to disengage rather than further engage patients.

To learn more…check out my latest white paper on Primary Care & Patient Engagement – In Search of the Holy Grail at http://bit.ly/JczOrc

http://twitter.com/Covvit Covvit Medical Group

If by “patient engagement” all we mean is that the patient has shown enough interest and follow-through to arrive at a healthcare facility then, sure, every patient is already engaged. But if we strive for the type of engagement that involves patient proactivity and meaningful, sustained doctor-patient dialogue, we also have to account for the many patients who arrive because a chronic condition has left them with no other choice, because they are in acute pain, because they have troubling symptoms and want a quick answer. When they receive a diagnosis or temporary relief will they take charge of their own health…or wait for the next crisis? Assuming that a patient is engaged in any real way simply because they’ve arrived at your office may, in many cases, be assuming too much.

Steve Wilkins

Since when is the process of seeking friends and family’s opinions, researching a medical condition on line, picking up the phone and making an appointment at your office and actually showing up not proactive or meaningful??? For godsakes it’s meaningful to the patient!! Why denigrate the patient’s side of the equation by suggesting that a patient’s perspective of engagement is somehow not a legitimate as a provider’s perspective?

The whole point of the post is that providers tend to ignore/dismiss patient motivations (to the point of never trying to see what they are – for example do you do proactive agenda setting with your patients?) Many practices don’t. The real danger is that is doing so patient’s may be leaving provider’s offices more disengaged that when they first came in.

meyati

There seems to be subtle but different meanings of the term “Patient engagement” in all of the comments and article. I tend to agree more with the Covvit Medical Group than the other opinions. One factor is being ignored-that a patient involved in their care-and care deeply might say, “No” to the doctor’s suggestions, no matter how great of a salesperson the doctor is. Everything that has been written so far has the implicit connotation that an ‘engaged patient’ will agree with the doctor’s diagnosis. The patient has a past that often doesn’t show up on intake paper work or even in records-especially older patients or patients with a complicated medical history that causes the patient to react psychologically in an unpredictable way.
As far as often diagnosing a medical condition by looking at the patient and chatting with one for a few minutes, I’ve ran into far too many people that just didn’t do well with doctors like that. My vitamin B6 and B 12 were low-out of range low. My iron level was high, so I spent months having MRIs, visiting a good neurologist, before out of desperation she ran the lab work. My primary care physician and the neurologist apologised profusely, I went to Walmart and bought some vitamins and I was OK a few months later. I didn’t look like a vitamin deficient person, and I wasn’t anemic. They thought that I probably had mini-strokes, or brain cancer, or MS or something. It was something-vitamin B deficencies.